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Related Experiment Videos

Clinical decision-making and mammography referral

K E Grady1, J P Lemkau, J M McVay

  • 1Massachusetts Institute of Behavioral Medicine, Inc., East Longmeadow 01028, USA.

Preventive Medicine
|May 1, 1996
PubMed
Summary

Physicians refer older women for mammograms less frequently, especially those over 80. Referral decisions are influenced by perceived patient age and potential benefit, highlighting a need for guideline evaluation.

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Area of Science:

  • Primary Care
  • Preventive Medicine
  • Geriatric Medicine

Background:

  • Mammography referral is influenced by physician, practice, and patient factors.
  • The impact of advanced patient age and comorbidity on referral decisions is understudied.

Purpose of the Study:

  • To investigate physician referral patterns for mammography in relation to patient age and comorbidity.
  • To identify factors influencing primary care physicians' decisions to refer older women for mammography.

Main Methods:

  • A survey of 132 community-based primary care physicians in two U.S. cities.
  • Physicians completed questionnaires regarding their mammography referral practices.

Main Results:

  • Referral rates decreased with patient age: 89% for 50-64, 83% for 65-74, and 57% for 80+.

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  • Lower referral rates were associated with foreign medical graduates, non-board-certified physicians, and residency-trained physicians for older patients.
  • Reasons for non-referral included assuming another physician would refer, cost, comorbidity, acute encounter type, and belief that the patient was too old to benefit.

    • Conclusions:

    • Physician referral patterns for mammography vary significantly by patient age, with a notable drop for those 80 and over.
    • The findings support a discussion on whether mammography guidelines should prioritize patient age or functional status.
    • There is a need to evaluate and openly discuss the decision-making rules physicians use for mammography referrals.